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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 171-174

Knowledge and practice of rubber dam usage among dental practitioners


1 Department of Public Health Dentistry, JKKN Dental College and Hospital, Komarapalayam, Tamil Nadu, India
2 Department of Periodontics, JKKN Dental College and Hospital, Komarapalayam, Tamil Nadu, India

Date of Submission30-Dec-2021
Date of Acceptance31-Jan-2022
Date of Web Publication26-Mar-2022

Correspondence Address:
Dr. Hariprasath Nagarajan
JKKN Dental College and Hospital, Komarapalayam, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcd.ijcd_40_21

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  Abstract 


Background: The purpose of the present study is to determine the rubber dam usage among dental practitioners, specifically focusing on endodontic treatment, evaluate the problems they encountered, and gather information about their prospective presumptions about using it in future. Aim: The aim of this study is to evaluate the information regarding the use of rubber dam among dental practitioners. Materials and Methods: The usage of rubber dam use has been quantified based on the questionnaires which were distributed to dental practitioners. Questions were asked about areas where the practitioners used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The questionnaire was then collected and evaluated. Descriptive statistics were calculated. Results: About 78% of the dental practitioners have adequate and satisfactory education regarding the use of rubber dam. Conclusion: Rubber dam makes dentistry easier, faster, safer, and more satisfying for the operator. This research concludes that it is necessary to increase the knowledge and awareness of dental practitioners about the rubber dam and its application

Keywords: Clinical practice, practitioners, rubber dam


How to cite this article:
Nagarajan H, Karuppanan P S. Knowledge and practice of rubber dam usage among dental practitioners. Int J Community Dent 2021;9:171-4

How to cite this URL:
Nagarajan H, Karuppanan P S. Knowledge and practice of rubber dam usage among dental practitioners. Int J Community Dent [serial online] 2021 [cited 2022 May 26];9:171-4. Available from: https://www.ijcommdent.com/text.asp?2021/9/2/171/341000




  Introduction Top


A dental dam or rubber dam, designed in the U. S. in 1864 by Sanford Christie Barnum,[1] is a thin, 6” square sheet usually latex or nitrile, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth. It is used mainly in endodontic, fixed prosthodontics (crowns, bridges), and general restorative treatments. Its purpose is both to prevent saliva interfering with the dental work (e.g., contamination of oral micro-organisms during root canal therapy, or to keep filling materials such as composite dry during placement and curing), and to prevent instruments and materials from being inhaled, swallowed, or damaging the mouth. In dentistry, the use of a rubber dam is sometimes referred to as isolation.[2]

The advantages and absolute necessity of the rubber dam must always take precedence over convenience and expediency (a rationale often cited by clinicians who avoid its use).[3] When properly placed, the rubber dam facilitates treatment by isolating the tooth from obstacles (saliva, tongue, lips, and cheeks) that can disrupt any procedure. Salient advantages of using rubber dam in endodontics include patient protection from aspiration of endodontic instruments[2],[4] tooth debris, medicaments, and irrigating solutions.[5] It improves visibility and helps in soft-tissue retraction and protection, thereby increasing efficiency. A surgically clean operating field is isolated from saliva, hemorrhage, and other tissue fluids. The dam reduces the cross-contamination of the root canal system, and it provides an excellent barrier to the potential spread of infection. The rubber dam minimizes patient conversation during treatment and the need for frequent rinsing. Clinician is protected from litigation because of aspiration or swallowing of an endodontic file by the patient.

Rubber dam offers an excellent means of infection control during dental treatment by mainly reducing bacterial contamination of any dental preparations or root canal systems.[6],[7] Furthermore, rubber dam prevents the transmission of any infectious agents. The rubber dam has been considered as a standard of care during operative and endodontic procedures, because of its many advantages.[8],[9] Rubber dam provides an infection control barrier during dental procedures by reducing the bacterial contamination of any dental preparation and root canal system.[10],[11] It also provides an infection control barrier for the dentists and patients by preventing the transmission of any infectious agent between them.

The purpose of this survey was to assess the usage of rubber dam among general dental practitioners and to analyze the different aspects of rubber dam usage in routine endodontic treatment.


  Materials and Methods Top


A cross-sectional questionnaire study was conducted among 100 dental practitioners, in Chennai. Convenient sampling methodology was used and the practitioners willing to participate and those who were present on the day of the survey were included in the study. Those practitioners not willing to participate in the survey were excluded from the study.

A self-administered questionnaire containing the items about the attitude and opinions of practitioners toward the usage of rubber dam was designed. Then, the questionnaire was piloted and distributed to 100 practitioners, and information about the opinions and attitudes of dentists toward the use of rubber dam were collected. Information related to the year of graduation, practice type and gender of the respondents, use of rubber dam in operative and endodontic procedures, practitioners' attitude to the use of rubber dam, and information related to dentist's reasons for using or not using rubber dam were sought in the questionnaire. The collected data were statistically analyzed. If the questionnaire was not filled completely, it was not excluded as a whole, and the completely filled questionnaire was taken into consideration in statistical analysis. Descriptive statistics were used to give the frequency and percentage distribution of the data.


  Results Top


About 78% of the dental practitioners have adequate and satisfactory education regarding the use of rubber dam. The greatest advantage offered by the rubber dam is the provision of isolation and an aseptic working area, prevention of swallowing or aspirating instruments, and prevention of ingestion of irritants [Figure 1]. Around 58% of practitioners accept that rubber dam is difficult to apply and the major factor for this is a selection of the clamp and its adaptation, placement of the rubber dam, and frame. About 58% of the dental practitioners find that rubber dam is difficult to apply. About 86% of the practitioners use it only during restorative procedures [Table 1]. Rubber dam is more necessary while working in the mandible (59%) than maxilla (31%). The rubber dam usage is extensively limited by 23% in third molar, 23% in malposed tooth, 18% in latex allergy patients, 13% in fractured tooth, and 18% in root stump [Table 2].
Figure 1: Study participants responses regarding the greatest advantage offered by the rubber dam

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Table 1: Distribution of study participants based on their attitude towards rubber dam usage

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Table 2: Distribution of study population based on their rubber dam usage during endodontic treatment

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The major factors that make rubber dam application a difficult procedure are a selection of the clamp and its adaption (54%), placement of the rubber dam (36%), and placement of the frame (10%) [Figure 2]. About 41% of dental practitioners use dam and clamp together method, rubber dam's first method is 34%, and clamp first method (25%). Around 86% of the dental practitioners use rubber dam during restorative procedures. Endodontic treatment can be used during access cavity preparation, root canal shaping, root canal filling, following anesthesia, and identification of root canal orifices [Table 3]. About 39% of undergraduate practitioners responded that they intended to use rubber dam during all procedures, 43% of the practitioners intended to use it only during restorative procedures and 18% of them intended to use only during root canal treatment.
Figure 2: Distribution of practitioners with regard to factor that makes rubber dam application a difficult procedure

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Table 3: Distribution of study population based on their opinion about limitation of rubber dam usage

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In the present study, 72% of the practitioners said that rubber dam usage shortens the treatment duration, whereas 28% of the practitioners reported that rubber dam usage extends the duration of treatment [Figure 3]. In the study, 82% of the practitioners preferred to use winged clamps and 18% of them preferred wingless.
Figure 3: Responses of practitioners for the question, “rubber dam shortens/extends treatment Duration”

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  Discussion Top


Rubber dam is mostly used for root canal treatment and the placement of composite fillings.[12],[13] The frequency of rubber dam usage increases significantly with increasing percentage of direct payments. Dentists are motivated more to use rubber dam as a quality standard method of operation field isolation in treatment. Barriers to the use of rubber dam apparently include lack of experience, underestimation of its benefits, and a lack of motivation[14] Another reason is that the amount of time required to place rubber dam is often overestimated.[15] Furthermore, dentists are often concerned that patients will not tolerate rubber dam.[16] If instructed properly, most patients tolerate rubber dam very well; many of them even find treatment with rubber dam more comfortable and bearable.[17] Another disadvantage of rubber dam has been reported as the difficulty of mounting radiographs in the proper position with the dam in place. On the other hand, the removal of the dam during radiography cannot be accepted as this step is specifically performed with an instrument within the root canal to determine the working length. During this step, the patient is generally left alone at the radiography site and there is no possibility of intervention in case of hazards occur. Therefore, radiographs should definitely be taken with the rubber dam placed in position. In other countries like Belgium, 64.5% of practitioners did not use rubber dam routinely, whereas only a very minor proportion (3.4%) believed rubber dam to be a standard procedure.[18] Stewardson and McHugh also indicated that the experience of the dentist and their level of skill influence the patient's opinion and suggested that proficiency regarding the utilization of rubber dam must be gained through frequent usage. Whitworth et al. stated that the negative perception regarding patients' dislike toward rubber dam may be related more strongly to practitioner attitude. In general, the presence of latex allergy was not asked to the patients by almost half of the practitioners, higher than the ratio reported by Mala et al. This result may suggest that more attention must be directed toward the possibility of latex allergy prior to application of the rubber dam considering some cases published.[13] The high percentage of practitioners who did not use rubber dam for child patients (89.1%) also exceeded the ratio (68%) reported by Mala et al.[13] This issue, however, needs to be considered from a pedodontic standpoint, probably in a future study focusing on this group of patients. Recently, there has been increasing effort to implement a malpractice law in the country, encompassing all health-care givers. This will necessitate taking more intensive measures by both practitioners as well as authorities for the provision of patient. Unlike the reasons cited by Marshall and Page (1990) in their study,[8] for not using rubber dam, the main reasons mentioned in our survey by the private practitioners in the UAE were patient discomfort minutes.[19] In addition, the extra time spent in placing the dam is more than compensated with better working conditions offered by the dam including controlling the saliva contamination and eliminating the need to frequently change cotton rolls as well as limiting the movements of the patient's tongue and lips. As it is already evident that rubber dam may reduce the incidence of posttreatment disease during root canal treatment.[20] The use of rubber dam in root canal procedures is considered the minimum safety standard of care.[21] The importance of the safety of the rubber dam is highlighted by the list of endodontic instruments that have been ingested or inhaled. Despite this, performing endodontic treatment without the rubber dam risks harming the patient and is considered legally indefensible.[21]


  Conclusion Top


It must be necessary to increase the awareness of dental practitioners to the benefits of rubber dam use by means of continuing education and stressing on its importance in studies. Rubber dam is mostly used for endodontic treatment and for the placement of composite fillings. Rubber dam makes dentistry easier, faster, safer, and more satisfying for the operator. It allows the practitioner to deliver a better quality of care and improved patient comfort.

Financial support and sponsorship

self funded.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Elderton RJ. A modern approach to the use of rubber dam – 1. Dent Pract Dent Rec 1971;21:187-93.  Back to cited text no. 1
    
2.
Lambrianidis T, Beltes P. Accidental swallowing of endodontic instruments. Endod Dent Traumatol 1996;12:301-4.  Back to cited text no. 2
    
3.
Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989;119:141-4.  Back to cited text no. 3
    
4.
Goultschin J, Heling B. Accidental swallowing of an endodontic instrument. Oral Surg Oral Med Oral Pathol 1971;32:621-2.  Back to cited text no. 4
    
5.
The Dentist Insurance Company, California Dental Association. Rubber dam it. Liabil Lifeline 2004;80:1-7.  Back to cited text no. 5
    
6.
European Society of Endodontology. Quality guidelines for endodontic treatment: Consensus report of the European society of endodontology. Int Endod J 2006;39:921-30.  Back to cited text no. 6
    
7.
Filipović J, Jukić S, Miletić I, Pavelić B, Malčić A, Anić I. Patient's attitude to rubber dam use. Acta Stomatol Croat 2004;38:319-22.  Back to cited text no. 7
    
8.
Gergely EJ. Desmond Greer Walker award. Rubber dam acceptance. Br Dent J 1989;167:249-52.  Back to cited text no. 8
    
9.
Shabana Khathoon SM, Raj JD. Use of rubber dam among dental practitioners – A questionnaire study. J Pharm Sci Res 2015;7:1007-10.  Back to cited text no. 9
    
10.
Mona F. Anabtawi et al. Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network, J Am Dent Assoc 2013; 144:179–86.  Back to cited text no. 10
    
11.
Rugg-Gunn AJ, Welbury RR, Toumba J; British Society of Paediatric Dentistry. British society of paediatric dentistry: A policy document on the use of amalgam in paediatric dentistry. Int J Paediatr Dent 2001;11:233-8.  Back to cited text no. 11
    
12.
Fayle SA, Welbury RR, Roberts JF; British Society of Paediatric Dentistry BSPD. British society of paediatric dentistry: A policy document on management of caries in the primary dentition. Int J Paediatr Dent 2001;11:153-7.  Back to cited text no. 12
    
13.
Mala S, Lynch CD, Burke FM, Dummer PM. Attitudes of final year dental students to the use of rubber dam. Int Endod J 2009;42:632-8.  Back to cited text no. 13
    
14.
Iwatani K, Matsuo K, Kawase S, Wakimoto N, Taguchi A, Ogasawara T. Effects of open mouth and rubber dam on upper airway patency and breathing. Clin Oral Investig 2013;17:1295-9.  Back to cited text no. 14
    
15.
Ahmad IA. Rubber dam usage for endodontic treatment: A review. Int Endod J 2009;42:963-72.  Back to cited text no. 15
    
16.
Slaus G, Bottenberg P. A survey of endodontic practice amongst flemish dentists. Int Endod J 2002;35:759-67.  Back to cited text no. 16
    
17.
Whitten BH, Gardiner DL, Jeansonne BG, Lemon RR. Current trends in endodontic treatment: Report of a national survey. J Am Dent Assoc 1996;127:1333-41.  Back to cited text no. 17
    
18.
Whitworth JM, Seccombe GV, Shoker K, Steele JG. Use of rubber dam and irrigant selection in UK general dental practice. Int Endod J 2000;33:435-41.  Back to cited text no. 18
    
19.
Kleier DJ, Shibilski K. Management of the latex hypersensitive patient in the endodontic office. J Endod 1999;25:825-8.  Back to cited text no. 19
    
20.
Kosti E, Lambrianidis T. Endodontic treatment in cases of allergic reaction to rubber dam. J Endod 2002;28:787-9.  Back to cited text no. 20
    
21.
Soldani F, Foley J. An assessment of rubber dam usage amongst specialists in paediatric dentistry practising within the UK. Int J Paediatr Dent 2007;17:50-6.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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